Tissue healing has three phases, Kelly Starrett told participants at a one day seminar at CrossFit Santa Cruz on March 14, 2009. Starrett is the owner of San Francisco CrossFit and a Doctor of Physical Therapy.

The inflammatory phase generally lasts 0-36 hours. The body has mobilized the troops. Swelling is maximal. The “emergency guys” are migrating from other tissues to help. That response is good, but needs to be slowed down. Immediate and frequent icing is essential. Icing once every two hours is best; twice a day is the bare minimum. Five minutes of ice massage using a paper cup equals 20 minutes of loosely packed ice applied to the injury. Starrett advises filling up a Dixie cup with water, freezing it and peeling away the edge. “That thing is freaky cold, pinpoint, brilliant icing,” he says. Icing stops pain messages from getting to the brain and the rebound effect after warming begins creates bloodflow that promotes healing.

The proliferative phase generally lasts two days to two weeks. New tissue, including scar tissue, is being laid down that needs to be re-modelled.

The remodeling phase generally last two to six weeks. An example of this phase is tendons being re-shaped. For trainers, the challenge is to prevent the cycle of re-injury that occurs if too much is attempted too soon.

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13 Comments on “Tissue Healing Phases”

One of the best series on injury and rehab CF has ever put out; keep 'em coming!
Any insight into osteolysis and repetitive forces brought on through regular training? Is this something that can be dealt with through self-rehab and prevention, or will there always be pre-existing dysfunction prior?

great article. I was one who made the mistake of pushing a tissue injury too soon. I had strained a calf muscle sprinting and began icing and in to see my therapist right away. Unfortunately 2-3 days later when the pain had disappeared I went back to the track and bam there is goes again. I jumped back on it right after the first phase and neglected the other two. It has now been nearly 6 weeks and I am slowing increasing intensity on it. Strangely though I will occasionally feel what can best be described as phantom sensation without any activity. Does anyone have thoughts on this phantom sensation.

Are there any textbooks you would suggest picking up to further our knowledge on the subjects germane to this video series? I have thoroughly enjoyed the series so far, and it has definitely spurred a new level of research on many different subjects.

I would love to hear suggestions on textbooks to delve further in to these matters.

Thank for the info Kelly. Your delivery is outstanding, the clarity and emphasis really communicates to me. This talk is totally relevant to me right now as I'm at day 8 with a strained hamstring (just completed the CF Level One cert in Vancouver this weekend!).

I'll be better-informed and more responsible in my rehab process as a result of your talks. Thank again!

I really find these videos extremely useful and as said above, Kelly's delivery is excellent. I'm having a nightmare with injuries at the moment and its a good reminder to break the cycle and not rush back too soon! (and also aim for a higher grade than C when it comes to icing!)

Good Stuff!!! Funny thing is that I am icing as I watch this. I am finding these videos very helpful and informative. I have always had a habit of pushing myself and wanting to come back to soon. This serves as a good reminder to let things heal properly and then get after it. My pec is doing great and part of it is because of these videos always showing up at the right time.

Question to Kelly Starrett: Pigeon Pose stretching exercise. Why does my shoulder hurt so much after the activity? The tissue does not seem to heal and I get a lot of clicking in my shoulder that was not there before. My gym owner said that the exercise is approved by a physical therapist, yet when I went to my physical therapist to get treatment for my shoulders he indicated that I should ask you why it was done. He indicated full shoulder internal rotation is much less than 90 degrees yet I am being force by another to get 90, why?

Question to Kelly Starrett: Pigeon Pose stretching exercise. Why does my shoulder hurt so much after the activity? The tissue does not seem to heal and I get a lot of clicking in my shoulder that was not there before. My gym owner said that the exercise is approved by a physical therapist, yet when I went to my physical therapist to get treatment for my shoulders he indicated that I should ask you why it was done. He indicated full shoulder internal rotation is much less than 90 degrees yet I am being force by another to get 90, why?

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